4 PAWS Community Center Dog Boarding and Daycare

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1 4 PAWS Community Center Dog Boarding and Daycare New Dog Interview Application Additional Family Member 2244 Franklin Rd. Bloomfield Hills, MI Update Existing Information (248) 230 PAWS OWNER INFORMATION: Guardian s/owner s Name Address City State Zip Home Phone # ( ) Employer: Work# ( ) Cell # ( ) Address May we add you to our list for reminders, specials, newsletters, etc.? (We will not give your address to anyone) Yes No DAILY EMERGENCY CONTACT NAME (someone you trust to make decisions about your pet) Name Relationship Home Phone # ( ) Work # ( ) Cell # ( ) OUT-OF-TOWN EMERGENCY CONTACT NAME (someone not traveling with you that you trust to make decisions about your pet) Name Relationship Home Phone # ( ) Work # ( ) Cell # ( ) Where will you be? How can we reach you? PET S INFORMATION: Pet s Name Birth Date / / Weight lbs. Breed Sex: Male Female Color MI License Number Microchip Number Yes, my pet is: Spayed Neutered When was Surgery performed? No, my pet is not spayed/neutered (required at 7 months+) Veterinarian Clinic Doctor s Name Phone # ( ) Address City State Zip VACCINATIONS: Written Documentation from Veterinary is required. Has your dog had any contagious diseases in the past 30 days? Yes No Explain: Requirements for Dogs (1 year or older) Rabies Vaccination Date / / Expiration Date / / Comments Distemper (DHLPP) Vaccination Date / / Expiration Date / / Comments Bordetella Vaccination Date / / Expiration Date / / Comments Fecal Exam Date / / Expiration Date / / Comments Requirements for Puppies (Under 1 year) Parvo virus Vaccination Date / / Expiration Date / / Comments Rabies Vaccination Date / / Expiration Date / / Comments Bordetella Vaccination Date / / Expiration Date / / Comments Fecal Exam Date / / Expiration Date / / Comments Heartworm Preventative? Flea Preventative? Allergies Special Needs MEDICATIONS: Yes No (Please list all medications/illnesses (heart, seizures, diabetes, hip problems, etc.) Medication Morning Afternoon Evening Quantity Illness / Reason Medication Morning Afternoon Evening Quantity Illness / Reason

2 FEEDINGS: Client Provided Brand Name Community Center Food Morning Quantity Afternoon Quantity Evening Quantity Treats? Indicate amount and when to give: HOW DID YOU HEAR ABOUT 4 PAWS COMMUNITY CENTER? Referral Drive-By Website Internet Search Yellow Pages Newspaper Flyer Special Event Referral: Name Other Have you ever used Dog Daycare or Overnight Boarding services? Yes No Please list What are your primary reasons for bringing your Dog to 4 PAWS Community Center? Loves To Play Travel Extensively Work Long Hours Dog needs a vacation Don t Like to Leave Alone All Day BEHAVIORAL INTERVIEW: (Please answer following questions as accurately as possible.) General Information: How long have you had your dog? If acquired less than 6 months ago, has your dog seen a vet? Yes No Date Where did you get your dog? How old was your dog when you got him/her? If purchased or adopted, do you have any knowledge of your dog s history? Has your dog ever stayed in a boarding facility before? Yes No Where/When? What did you like/dislike about the experience/facility? Has your dog ever been to Dog Daycare before? Yes No Where/When? What did you like/dislike about the experience/facility? Has your dog ever been expelled from Dog Daycare before? Yes No If Yes, Why/When? Are there any children in your household? Ages? How does your dog behave around other children? Is there one family member that is the primary caregiver to this dog? Who? Are there any other animals in your household? If so, please list the type, sex, and age of each: How does your dog get along with the other animals? Health and Grooming: Does your dog have a problem with fleas? Yes No Does your dog have hip dysplasia? Yes No If so, What restrictions need to be placed on your dog s activities or movements? Does your dog have any past injuries or current conditions? Yes No If Yes, Explain: Does your dog have any sensitive areas on his/her body? Yes No If Yes, Explain: Where are your dog s favorite petting spots? Does your dog like to be brushed? Yes No Bathed? Yes No How does your dog react to having his/her nails clipped? Do you use a professional groomer for your dog? Yes No Who? Behavior: Describe your Dog: Shy Mellow Aggressive Excitable Active Inactive Content with others Comments: Is your dog afraid of any specific items or noises? Yes No If Yes, Explain: How does your dog react to strangers coming into your home or yard? Does he/she bark or growl at anyone passing outside your home or yard?

3 Behavior (Continued): Is there any kind of PERSON, type of DOG, or SITUATION your dog reacts to? Yes No Please describe Has your dog ever bitten, growled at, bared teeth, or snarled at another PERSON or DOG? Yes No If yes, what were the circumstances? Are there any areas on your dog s body where they DO NOT like to be touched by humans? Yes No If yes, which areas? What is your dog s favorite activity? Are there any restrictions that should be placed on your dog s activities? Yes No If yes, what activities? Has your dog ever been around puppies? Yes No How does he/she react? Describe your dog s daily routine when you are not at home: Does your dog have separation anxiety when left alone? Has your dog ever been destructive in your home? If yes, explain: Does your dog play with any toys? Yes No Favorite toys or games? Has your dog ever socialized with a large group of dogs? Yes No Please describe Has your dog ever played with dogs over 15 pounds? Yes No Does your dog prefer to play with any specific breed, size of dog, or sex (M/F)? Will your dog readily share toys with other dogs? Yes No What happens when someone tries to take food or toys from your dog? Does your dog have any problems in the following areas? Mouthiness/Nibbling Excessive Barking Jumping on you Jumping on Others Digging House Training Others: Please explain any checked items: Has your dog ever jumped a fence? Yes No Is your dog aggressive on leash? Yes No Off leash? Yes No Has your dog had any formal obedience training? Yes No When/Where? What words do you say for the following commands? Sit Stay: Bedtime/Naptime: Bathroom: Eating Time: No Barking: To let go of something: Other Commands: Would you be interested in taking an obedience class here? Yes No What else should we know about your pet? PAYMENT METHOD for Daycare and Overnight Fees: (Visa, Mastercard, and Discover cards are accepted) Credit Card Type Number Expiration Date CW2 # Persons Authorized to Drop Off and/or Pick-Up my pet(s) (Must be at least 16 years old please include names and phone numbers) As the guardian/owner, I agree to conform to and be bound by the 4 PAWS Community Center policies and procedures as they may be amended. In the event of failure by me or my pet to conform with such rules, I understand that my pet may be denied access to 4 PAWS Community Center. I have reviewed and understand the current policies and procedures attached to this application. Guardian s/owner s Name (Print) Guardian s/owner s Signature Date Thank you for filling out this lengthy form. This information will help the staff at 4 Paws Community Center to make sure your dog feels at home when they are in our care.

4 POLICIES & PROCEDURES: As the guardian/owner of the pet, I understand that 4 PAWS Community Center, its owners, employees, officers, directors and agents (collectively referred to as 4 PAWS ) will exercise due care to protect the health and safety of my dog while in their care, and in the event my dog becomes ill or sustains injury, I have given permission for those in charge to take whatever steps are necessary to obtain medical treatment for my dog, and I agree to pay all charges incurred. I consent to any veterinarian being retained to render care for my dog. I understand that the concept of dog daycare and overnight care is to allow for dogs to be socialized by interacting with people and dogs. As always, with the interaction of dogs, there is a chance of injury. I assume all risk of injury to my dog while at 4 PAWS Community Center or in transportation to any veterinarian clinic, so long as reasonable care is taken to prevent any unnecessary injury, death, or loss. Also, if I ask for more than one dog to be placed in the same condo for boarding, I assume liability for any injuries they cause to each other. I also understand that although 4 Paws Community Center requires that all dogs attending are healthy and up-to-date on vaccinations, some contagious illnesses may not show symptoms that can be detected by the pet owners or 4 Paws Community Center staff. Since Dogs are intermingling, there is a chance that your dog may contract a contagious condition such as canine cough (canine influenza), puppy warts, or an intestinal parasite. By entering my dog in 4 PAWS Community Center facility, I agree not to file any legal charges, demands, or claims against 4 PAWS Community Center and/or its owners, employees, officers, directors and agents for any injury, death or loss of my dog. I hereby waive and release 4 PAWS Community Center and/or 4 PAWS from any and all liability of any nature for any injury, death or loss of my dog resulting from their actions or from the action of my dog or any other dog while in the custody of, or on the grounds or surrounding area of 4 PAWS Community Center. If a life threatening injury or death occurs, 4 PAWS will notify me immediately to receive specific instructions on how to proceed or to advise me that my dog is being taken to its veterinarian on file. In the event my dog causes injury to another dog or to a person while at 4 PAWS Community Center, I agree to indemnify and subrogate 4 PAWS Community Center and 4 PAWS from any action which may be brought against them, and for any defense, settlement, or judgment against them. I will assume all liability for the actions of my dog and agree to maintain personal liability insurance to cover me in the event of such an incident. ENTRANCE REQUIRMENTS FOR DOGS Must be 4 months of age or older. Must be spayed or neutered if over 6 months of age. Must be current on Rabies, Distemper and Bordetella vaccinations and have had a negative fecal exam in the past year. Owner/Guardian must submit written proof of all vaccinations. (Note: Bordatella vaccine requires two boosters annually and most veterinarians only administer this only when specifically requested) Owner/Guardian must have owned the dog(s) a minimum of 30 days. Must be in good health and flea/tick free. Owners must certify that their dog(s) has not been ill with a communicable condition in the past 30 days. Must be non-aggressive and not toy or food protective. Owners must certify that their dog(s) have not harmed or shown aggressive or threatening behavior towards any person or any other dog(s). Please remember that your pet will be spending time with other pets and the safety and health of all animals is our primary concern. Must have completed the application form, and provided copies of your vaccination records to 4 Paws Community Center. We must have all of this information prior to your scheduled reservation Must complete the Behavioral Assessment. This is free of charge and may be done during your dog s first visit We ask that the first 3 visits occur within the first two weeks. This will allow your dog to become familiar with the Daycare facility, the other dogs, and the staff. It will make the adjustment to Daycare much easier and less stressful on your dog. ** DAYS AND HOURS Our business hours are from 6:30 AM to 7:00 PM Monday through Friday for our daycare and overnight guests. Holiday and Weekend hours are by appointment only. Appointments are preferred between 9:00 AM and 11:00 AM or between 4:00 PM and 6:00 PM. ** WEEKEND DAYCARE Daycare is now available on the weekends by appointment only. Your dog must be dropped off and picked up at your designated appointment time. Please call for an appointment Monday through Friday prior to the weekend that you d like to drop off for daycare. Weekend daycare will be charged for a full day regardless of the length of the stay (half day rates are not available on the weekend)

5 **PAYMENT Owner agrees to pay the rate for pet care services in effect on the date that the pet is checked into 4 Paws Community Center. For new customers, we accept cash, VISA, MasterCard, and Discover. Existing loyal customers may also pay by personal check. A fee of $25 will be applied to returned checks **DAYCARE PACKAGES Packages may be purchased for full days or half days. Full day packages cannot be used for half days. Full day packages must be used for full days of daycare only. Half days may be purchased separately or via a half day package. Boarding packages are also available. LATE FEES - For day care, your dog will be boarded overnight if you are more than 15 minutes late. There is a dollar per minute late charge up to $15. You will also be charged the overnight boarding fee in addition to the daycare fee. For overnight boarding late pick-up, if you do not call 24 hours ahead to alert us that you will not be picking up your dog on the scheduled day, you will be charged double the boarding fee for each night after your scheduled date of departure. RESERVATIONS We ask that you make reservations so that we may assign our play groups in advance. Space is limited, so please make your reservations at least 48 hours in advance. We honor reservations on a first-come-first-serve basis. We will try our best to accommodate, but please make your reservations early, especially during peak holiday seasons. A $75 deposit is required for new customer booking a holiday stay. CANCELLATION POLICY - We ask for you to cancel 48 hours in advance of your day care or overnight reservation. Day Care members are charged the normal rate for a no-show and overnight guests are charged a minimum of a two-night cancellation fee. 72 hours notice is required to cancel a holiday boarding reservation without a financial penalty. AGGRESSIVE DOGS - We do not accept aggressive dogs. Our interview process screens for aggression. If an accepted dog exhibits unacceptable behavior, the dog is given a timeout and the owner is informed of the incident. We will then work with the owner to resolve the situation or the dog will be asked not to return to day care or overnight boarding. MEMBERS FAILING THE INTERVIEW PROCESS OR EVICTION FROM THE COMMUNITY CENTER - This can happen but it s not the end of the world. We do what is best for all of our guests. If your dog fails the interview, it doesn t mean we do not love your dog. This unique environment may just be too overwhelming. Some dogs just need a little training and socialization before coming to the community center. Typical reasons that dogs may fail the interview are as follows: Aggressive Behavior, Extreme Anxiety, Excessive Mounting, Severe Medical Problems, Biting Staff, Biting Other Dogs, Food or Toy Protective, Not a Good Fit FOOD & TREATS - If your dog is scheduled for daycare, and you wish for your dog to have lunch, bring your own container or baggie with their name on it. Dogs are not given anything you don t bring. Most dogs do fine without lunch but it is your choice. There is no food allowed in the play area so all dogs who are eating are separated and placed in a private room. We also recommend that the owners provide food for dogs staying overnight, as this is easier on the pet s system to have the food products that they are accustomed to. If owners do not provide their own food, 4 PAWS will provide them with the brand that they use. COLLAR AND LEASH - All dogs must have a quick release collar with a tag with your current contact information, as well as the pet s name. On occasion we will remove your dog s collar when entering the play area to prevent collars getting caught up during play. All of your pet s items will be placed in a bin with your dog s name on it. All dogs must enter and exit the Community Center on a standard leash (retractable leashes or flea and tick collars are not permitted). VALUABLE AND PERSONAL PROPERTY 4 PAWS Community Center and 4 PAWS are not liable to you for your personal property if damaged, lost, or stolen while on or around 4 PAWS Community Center s premises. If your dog causes any damage to 4 PAWS Community Center facilities or equipment, you as the owner are liable to 4 PAWS for the full cost of repair or replacement. FINANCIAL POLICIES - Fees for Services & Products: The owner agrees to pay for day care and boarding fees, services or products with the credit cards listed on the front of this application or by cash or check. By listing your credit cards on the front of this application you are allowing 4 PAWS Community Center to debit your credit card account for services, fees or products. You agree to pay an administrative fee for any returned check, or debit problems, such as non-sufficient funds, closed account, frozen or declined credit or similar circumstances. REFUNDS: Please review the 4 PAWS community center s refund policy available at the front desk. WATCHING YOUR DOG ON THE WEB CAM - Simply log onto the Internet and go to our web site at Click on the Web Cam button and watch your pet having a dog gone good time. WEB CAMS, PHOTOS & VIDEO RELEASE I agree to release any and all of my dog s image(s) in video or photo to the 4 PAWS Community Center for local, national and/or the World Wide Web (internet) marketing. For use, reuse, and/or publishing and republishing of in any media and for any uses, including, but not by way of limitation, illustration, promoting, advertising and trade, and to use my dogs name in connection therewith. This is binding upon me and my heirs, legal representatives and assigns.

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